The overall goal of this K08 mentored clinical scientist research career development award is to develop Dr. Michael Rinke into an independent clinical investigator in pediatric patient safety and quality, focusing on eliminating ambulatory central line-associated blood stream infections (CLABSIs). This goal will be accomplished during the grant period through doctorate level coursework in survey and cohort designs at the Johns Hopkins Bloomberg School of Public Health, advanced training in patient safety methodologies at Johns Hopkins' Center for Innovation in Quality Patient Care and at the Institute for Health Care Delivery and Research at Intermountain Healthcare, intensive mentorship from experienced health services researchers such as Dr. Marlene Miller, Dr. Allen Chen, Dr. Aaron Milstone and Dr. David Bundy and protected research time focused on CLABSIs in ambulatory pediatric oncology patients. Dr. Rinke's patient safety research aims to understand the epidemiology of ambulatory pediatric oncology patient CLABSIs and evaluate strategies to decrease ambulatory CLABSIs using best-practice care bundles. CLABSIs cause significant morbidity and mortality in all patients and are understudied in ambulatory populations. Dr. Rinke's research will 1) compare the burden of ambulatory pediatric oncology patient CLABSIs to inpatient pediatric oncology patient CLABSIs via CLABSIs counts, and describe specific risk factors and outcomes associated with ambulatory CLABSIs. The proposal will also 2) compare both pediatric homecare agency central line care policies and ambulatory pediatric oncology family central line care practices with best-practice central line care bundles, and describe barriers to implementation of best-practice central line care bundles in these populations. Finally, this proposal will 3) determine whether consistent clinic, homecare agency and family implementation of best-practice central line care bundles is associated with a decrease in ambulatory pediatric oncology patient CLABSI rates. Evaluating strategies to prevent CLABSIs in ambulatory pediatric oncology patients will improve outcomes for this vulnerable population. Successful completion of these projects will allow Dr. Rinke to become an independent clinical investigator and spread ambulatory CLABSI prevention efforts to other institutions and to other ambulatory pediatric and adult populations with long-term central lines. . PUBLIC HEALTH RELEVANCE: This proposal will evaluate strategies to decrease harmful central line-associated blood stream infections in ambulatory pediatric patients. Successful completion will generate an evidence base to prevent central line infections in all care settings, including homes and clinics.